Lunzer M, Barnes P, Byth K, O'Halloran M
Gastroenterology. 1986 Oct;91(4):825-9. doi: 10.1016/0016-5085(86)90682-7.
We have prospectively studied changes in serum postprandial cholylglycine (CG) concentration during 297 pregnancies. We found an increase in CG concentration from 0.3 mumol/L at 15 weeks' pregnancy to 0.6 mumol/L at 40 weeks' pregnancy. Although this increase was statistically significant (p less than 0.005), median concentrations of CG remained well within the normal range (0-1.5 mumol/L). However, 10% of the group showed markedly elevated serum CG concentrations at 30 weeks' pregnancy, and the CG level in this group continued to rise during the third trimester. Pruritus was significantly more common in the group with elevated CG concentrations (48%) than in the group with normal CG levels (20%) (p less than 0.005). Serum CG was a much more sensitive predictor of pruritus during pregnancy than other biochemical liver tests. Elevated CG levels were found more commonly in Mediterranean and Asian patients than patients of other ethnic origins (p less than 0.025). No statistically significant associations were found between elevated CG concentrations and maternal age, number of previous pregnancies, pruritus during previous pregnancies, contraceptive-induced cholestasis, and fetal maturity. We conclude that obstetric cholestasis is probably much more common than previously suspected and that consideration should be given to the measurement of serum bile acids in all pregnant individuals with unexplained pruritus.
我们前瞻性地研究了297例妊娠期间血清餐后胆酰甘氨酸（CG）浓度的变化。我们发现CG浓度从妊娠15周时的0.3μmol/L升高至妊娠40周时的0.6μmol/L。尽管这一升高具有统计学意义（p<0.005），但CG的中位数浓度仍处于正常范围内（0 - 1.5μmol/L）。然而，该组中有10%的孕妇在妊娠30周时血清CG浓度显著升高，且该组的CG水平在妊娠晚期持续上升。CG浓度升高组的瘙痒发生率（48%）显著高于CG水平正常组（20%）（p<0.005）。与其他生化肝功能检查相比，血清CG是妊娠期间瘙痒更敏感的预测指标。在地中海和亚洲患者中，CG水平升高的情况比其他种族的患者更为常见（p<0.025）。在CG浓度升高与产妇年龄、既往妊娠次数、既往妊娠期间的瘙痒、避孕药引起的胆汁淤积以及胎儿成熟度之间未发现统计学上的显著关联。我们得出结论，产科胆汁淤积可能比之前怀疑的更为常见，对于所有不明原因瘙痒的孕妇，都应考虑检测血清胆汁酸。
